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84 Cards in this Set
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LYMPHOMA/LEUKEMIA
356. Unlike most small lymphocytic lymphomas, MALT lymphomas are associated with negative test results for which of the following immunophenotypic markers? A. CD5 B. CD19 C. CD20 D. CD21 |
Answer 356 is A. Unlike most small lymphocytic lymphomas, MALT lymphomas are
distinctive morphologically, phenotypically and clinically and are CD5 negative. |
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359. Which of the following adverse effects is most commonly associated with the
administration of CHOP chemotherapy? A. Foreshortened limbs B. Red man syndrome C. Pulmonary toxicity D. Cardiotoxicity |
Answer 359 is D. Of the above choices, cardiac toxicity is most often associated with the
administration of CHOP due to the doxorubicin. |
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364. Which of the following chemotherapy regimens is NOT one of the treatment arms in the
German Hodgkin Study Group (HD 9) prospectively randomized trial on advanced Hodgkin disease? A. MOPP-ABV B. COPP-ABVD C. Standard BEACOPP D. Dose-increased BEACOPP |
Answer 364 is A. It was a 3-arm trial comparing COPP-ABVD, standard BEACOPP and dose increased BEACOPP.
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367. Which of the following drugs is NOT part of the Stanford V chemotherapy regimen?
A. Vinblastine B. Dacarbazine C. Mechlorethamine D. Etoposide |
Answer 367 is B. The drugs in the Stanford V regimen are: Mechlorethamine, Doxorubicin,
Vinblastine, Vincristine, Bleomycin and Prednisone. |
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374. Which of the following findings is most commonly associated with patients who present
with chronic lymphocytic leukemia? A. Anemia B. Splenomegaly C. Hepatomegaly D. Lymphadenopathy |
Answer 374 is D. Eighty-five to 90% of patients with CLL present with peripheral
lymphadenopathy. |
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12. Which of the following chromosomal translocations is most commonly associated with Burkitt lymphoma?
A. t(8;14) B. t(9;22) C. t(11;14) D. t(14;18) |
Correct answer is A. RATIONALE: Option B is the correct answer for chronic myelogenous leukemia (CML), option C is for mantle cell lymphoma, and option D is for follicular lymphoma.
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35. Which of the following antigens is a T-cell marker?
A. CD7 B. CD20 C. CD30 D. CD40 |
THIS ITEM WAS NOT SCORED. RATIONALE: T-cell lineage is evident from the presence of T-cell markers (CD3, CD2, and CD7).
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38. According to the National Comprehensive Cancer Network (NCCN) guidelines, which of the following radiation dose ranges would be most appropriate for treatment of intermediate-grade non-Hodgkin lymphoma?
A. 10 Gy to 15 Gy B. 30 Gy to 40 Gy C. 50 Gy to 55 Gy D. 60 Gy to 70 Gy |
Correct answer is B. RATIONALE: National Comprehensive Cancer Network (NCCN) guidelines specify 30 Gy to 36 Gy or 40 Gy in the case of bulky disease.
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51. Which of the following factors is included in the international prognostic index (IPI) for non-Hodgkin lymphoma?
A. Histology B. Weight loss C. Lactate dehydrogenase (LDH) level D. Erythrocyte sedimentation rate (ESR) |
Correct answer is C. RATIONALE: The international prognostic index (IPI) consists of stage, age, performance status, LDH, and number of extranodal sites.
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63. CHOP chemotherapy contains which of the following drugs?
A. Vinblastine B. Hydroxyurea C. Prednisone D. Carmustine |
Correct answer is C. RATIONALE: CHOP chemotherapy includes cyclophosphamide, doxorubicin, Oncovin, and prednisone.
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75. Which of the following histologies is most likely to be associated with primary CNS lymphoma?
A. Burkitt B. Follicular C. Hodgkin disease D. Diffuse large B-cell |
Correct answer is D. RATIONALE: Most primary CNS lymphomas are diffuse large B-cell, immunoblastic or lymphoblastic lymphomas.
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103. What is a major criterion for the diagnosis of multiple myeloma?
A. Calcium level of >12 mg/dL B. Hemoglobin level of 8.5 g/dL C. Plasmacytoma on tissue biopsy D. Lytic bone lesions on skeletal survey |
Correct answer is C. RATIONALE: Major criteria are plasmacytoma on tissue biopsy, bone marrow plasmacytoses of >30% plasma cells, and elevated monoclonal globulin spike on serum electrophoresis above a defined level.
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115. Which of the following radiation dose ranges is most commonly used to treat solitary plasmacytoma?
A. 15 Gy to 20 Gy B. 24 Gy to 30 Gy C. 40 Gy to 50 Gy D. 60 Gy to 70 Gy |
Correct answer is C. RATIONALE: Dose response data indicate that 40 Gy to 50 Gy will control most solitary plasmacytomas.
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131. Which of the following factors is most strongly linked to an increased risk for the development of multiple myeloma?
A. Alcohol use B. Tobacco use C. Mustard gas exposure D. Ionizing radiation exposure |
Correct answer is D. RATIONALE: Ionizing radiation exposure is a risk factor for multiple myeloma, as shown by a marked increase of this tumor in Hiroshima survivors.
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132. Which of the following types of acute leukemia occurs most commonly during childhood?
A. Pre-B cell lymphocytic B. Mature B-cell lymphocytic C. Mature T-cell lymphocytic D. Monocytic myelogenous |
Correct answer is A. RATIONALE: This item is based on the epidemiology of childhood leukemia. Acute lymphocytic leukemia (ALL) comprises 80% of all acute leukemias in childhood. Most are the pre-B cell type.
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146. Which of the following anatomical sites is most commonly associated with extraosseous, soft tissue plasmacytomas?
A. Back B. Pelvis C. Lower extremity D. Head and neck |
Correct answer is D. RATIONALE: Extramedullary plasmacytomas arise most frequently in the head and neck and upper respiratory tract.
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147. Which of the following types of acute leukemia is most likely to be associated with a 12-year-old boy who presents with a large mediastinal mass and lymphoblasts in his blood?
A. Pre-B cell lymphocytic B. Mature B-cell lymphocytic C. Mature T-cell lymphocytic D. Monocytic myelogenous |
Correct answer is C. RATIONALE: This item is based on the epidemiology of childhood leukemia. This is a classic presentation of mature T-cell lymphocytic leukemia (older boy with a mediastinal mass).
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150. Which of the following cell markers is most commonly associated with classic Hodgkin lymphoma?
A. CD15+, CD30+ B. CD15+, CD30- C. CD15-, CD30+ D. CD15-, CD30- |
Correct answer is A. RATIONALE: Classical Hodgkin lymphoma has cell markers CD15+, CD30+, and can be CD20+ or CD20-. A is the only possible answer.
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89. Approximately what percent of patients who have follicular non-Hodgkin lymphomas present with B symptoms?
A. 75% B. 50% C. 25% D. 05% |
Correct answer is D. RATIONALE: B symptoms occur very infrequently in non-Hodgkin lymphoma and usually are associated with stage III or IV disease.
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162. Which of the following factors is associated with a higher risk for the development of Hodgkin lymphoma in economically developed countries?
A. Early birth order B. Increased number of siblings C. Increased number of playmates as child D. Chronic immunosuppressant treatment |
Correct answer is A. RATIONALE: Hodgkin lymphoma has been found to be related to the level of maternal education for younger patients, decreased number of playmates, decreased number of siblings, and early birth order in economically developed countries.
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192. Hodgkin lymphoma most commonly occurs during which decade of life?
A. Second B. Third C. Fourth D. Fifth |
Correct answer is B. RATIONALE: The majority of Hodgkin lymphoma cases occur during the third decade (20 to 30 years of age). The incidence is bimodal, though, with a second peak in incidence (although much smaller) after 50 years of age or in the sixth decade onward.
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212. A 22-year-old man with Hodgkin disease has adenopathy of the right cervical and right supraclavicular regions and weight loss of >10% of his baseline body weight. Which of the following cancer stages is most likely to be associated with this patient's condition?
A. Stage IA B. Stage IB C. Stage IIA D. Stage IIB |
Correct answer is B. RATIONALE: The patient has significant weight loss and night sweats, both of which qualify as "B" symptoms. The cervical and supraclavicular lymph node chains are considered a unified area for the purpose of staging and management. Hence, the patient has cancer stage IB.
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222. Which of the following radiation doses were compared in the randomized treatment arms of the German Hodgkin Study Group, HD 10 trial of patients with early-stage disease?
A. 36 Gy vs. 40 Gy B. 24 Gy vs. 36 Gy C. 20 Gy vs. 30 Gy D. 00 Gy vs. 20 Gy |
Correct answer is C. RATIONALE: The randomization of radiation therapy is 20 Gy vs. 30 Gy, which followed a randomization of 2 versus 4 cycles of ABVD systemic therapy.
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238. Which of the following Hodgkin lymphoma subtypes is most closely associated with the development of non-Hodgkin lymphoma?
A. Nodular sclerosis B. Lymphocyte depleted C. Lymphocyte predominant D. Lymphocyte rich |
Correct answer is C. RATIONALE: Compared to other subtypes, there is a documented association between lymphocyte-predominant Hodgkin lymphoma and non-Hodgkin lymphoma. The risk is thought to be approximately 3% (relative risk of 1.8), and the risk is presumed to be independent of therapy.
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258. Which of the following lymph node chains is most commonly involved in patients who present with Hodgkin lymphoma?
A. Inguinal B. Paraaortic C. Mediastinal D. Cervical |
Correct answer is D. RATIONALE: Approximately 60% to 80% of patients with Hodgkin lymphoma present with cervical/supraclavicular adenopathy. Approximately 50% of patients have mediastinal lymph node involvement.
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276. Which of the following factors increases a patient's risk for the development of leukemia?
A. Occupational exposure to benzene B. Occupational exposure to aluminum C. Use of mitomycin C D. Exposure to HPV |
Correct answer is A. RATIONALE: Risk factors for leukemia include radiation exposure/atomic bomb experience, smoking, and benzene exposure. There has been no established relationship to viral exposure with HPV, mitomycin C, aluminum, or thalidomide.
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296. Which of the following factors is associated with chronic myelogenous leukemia?
A. t(5;17) B. t(9;22) C. Trisomy 8 D. Trisomy 21 |
Correct answer is B. RATIONALE: The chromosomal translocation t(9;22) is called the "Philadelphia (Ph) chromosome," and translocation of the BCR and ABL genes are present in approximately 90% of chronic myelogenous leukemia (CML) cases.
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316. Which of the following types of leukemia has the highest risk of CNS involvement?
A. Acute lymphocytic B. Acute myelogenous C. Chronic myelogenous D. Chronic lymphocytic |
Correct answer is A. RATIONALE: The eye/ocular region, testicles, and central nervous system (CNS) are common sanctuary sites in acute lymphocytic leukemia (ALL), with the CNS being the most common. Because of this, CNS prophylaxis is often employed.
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327. Which of the following types of leukemia is associated with myeloperoxidase activity and cell markers CD13 and CD33?
A. Acute lymphocytic B. Acute myelogenous C. Chronic myelogenous D. Chronic lymphocytic |
Correct answer is B. RATIONALE: Myeloperoxidase activity and cell markers CD13 and CD33 are related to acute myelogenous leukemia (AML). Cell markers CD2, CD5, and CD7 are related to T-cell acute lymphocytic leukemia (ALL), and CD10, CD19, and CD22 are related to B-cell ALL.
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352. Which of the following types of leukemia has the highest incidence rate?
A. Acute lymphocytic B. Acute myelogenous C. Chronic myelogenous D. Chronic lymphocytic |
Correct answer is D. RATIONALE: Chronic lymphocytic leukemia (CLL) is approximately twice as common in men as in women and is more common than other leukemias.
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2. Which of the following translocations is associated with mantle cell lymphoma?
A. t(8;14) B. t(11;14) C. t(11;18) D. t(14;18) |
Correct answer is B. RATIONALE: T(11;14) is an established translocation associated with mantle cell lymphoma.
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11. According to the GELA study, the use of CHOP plus radiation therapy compared to
CHOP alone for patients older than 60 years of age with stage I and stage II non-Hodgkin's lymphoma resulted in: A. a higher percentage of treatment-related death. B. a significant improvement in event-free survival. C. a significant improvement in overall survival. D. no significant difference in overall survival. |
Correct answer is D. RATIONALE: There was no significant difference in overall survival (OS) or event-free survival (EFS) in the GELA study. Reference: Journal of Clinical Oncology. 2007;25:787-792.
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14. The international prognostic index (IPI) for non-Hodgkin's lymphoma includes which of
the following patient criteria? A. Age B. Fever C. Weight D. Pruritus |
Correct answer is A. RATIONALE: The international prognostic index (IPI) for non-Hodgkin’s lymphoma includes lactic dehydrogenase (LDH) level, involvement of extranodal sites, age, performance status (ECOG), and cancer stage.
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40. A bone marrow biopsy would be most appropriate for which of the following clinical
stages in patients with Hodgkin's lymphoma? A. IA B. IIA C. IIB D. IIIC |
Correct answer is C. RATIONALE: Bone marrow biopsy is recommended in patients who have clinical stages IB-IIB and III and IV Hodgkin’s lymphoma.
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45. Which of the following is NOT a histological subtype of Hodgkin's lymphoma?
A. Mixed cellularity B. Mixed sclerosis C. Nodular sclerosis D. Lymphocyte depleted |
Correct answer is B. RATIONALE: Mixed sclerosis is not a histological subtype of Hodgkin’s lymphoma.
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62. Which of the following risk factors is most commonly associated with the development of
gastric lymphoma? A. Epstein-Barr virus B. Human papilloma virus (HPV 16) C. Helicobacter pylori D. Borrelia burgdorferi |
Correct answer is C. RATIONALE: Helicobacter is well recognized as an associated risk factor in gastric lymphoma. Eradication of Helicobacter pylori with antibiotics often results in resolution of the lymphoma.
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68. Which of the following statements about chronic lymphocytic leukemia (CLL) in adults is
true? A. The median age at diagnosis is 30 years. B. It occurs less frequently than acute lymphocytic leukemia (ALL). C. More than 50% of patients will develop a more aggressive lymphoid malignancy. D. The prognosis is primarily determined by the disease stage. |
Correct answer: ABCD. RATIONALE: Staging systems (such as Rai and Binet) are commonly used to determine the extent of sites of disease involvement and severity of hematological abnormalities, which determine the prognosis and overall survival of patients with chronic lymphocytic leukemia (CLL). Patients with CLL usually present at an older age (median age of 60 years old). CLL is more common than acute lymphocytic leukemia (ALL) in adults. About 5% to 15% of CLL will evolve into a more aggressive lymphoid malignancy.
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80. Which of the following agents is NOT included in the ABVD chemotherapy regimen?
A. Bleomycin B. Doxorubicin C. Vinblastine D. Dexamethasone |
Correct answer is D. RATIONALE: Dexamethasone is not an agent in ABVD chemotherapy. All of the other options as well as dacarbazine are agents in the ABVM chemotherapy regimen.
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85. Which of the following special precautions should be used when treating a patient with
total skin electron irradiation? A. A large Lucite screen to reduce the skin dose B. Dual electron beams angled ±20o off of the central axis to reduce the x-ray contamination C. High-energy electrons (>19 MeV) to ensure the appropriate depth of penetration D. Custom blocks designed to minimize the lung dose |
Correct answer is B. RATIONALE: This question requires knowledge of the American
Association of Physicists in Medicine Task Group 30 (AAPM TG30) report. Option A is false, since the screen acts to degrade the energy of the incident beam, thereby shifting the PDD to produce a shallower depth dose, and a higher skin dose. Option C is false, since typical treatment energies range from 4 to 10 MeV, according to the AAPM TG30 report. Option D is false, since lung blocks are typically used when treating a patient with total-body photon irradiation. Since electrons have a rapid dose falloff beyond dmax, lung blocks are not necessary when treating a patient with total skin electron irradiation. |
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92. According to the Chronic Leukemia-Myeloma Task Force, which of the following findings
is required for a diagnosis of plasma cell myeloma in patients who have normal paraimmunoglobulin findings and radiographic evidence of osteolytic lesions with palpable tumors? A. WBC count of >15,000 cells/mL in the absence of other disease capable of causing reactive leukocytosis B. Marrow plasmacytosis of >20% in absence of other disease capable of causing reactive plasmacytosis C. Hemoglobin value of <10 mg/dL D. Plasma blood level of >500 cells/mL |
Correct answer is B. RATIONALE: Since a number of patients with plasma cell neoplasms present without paraimmunoglobulinopathy, it is important to know the criteria for establishing a diagnosis for this group of patients. According to the Chronic Leukemia-Myeloma Task Force guidelines, there has to be a marrow plasmacytosis greater than 20% in absence of other disease capable of causing reactive plasmacytosis in addition to paraimmunoglobulinopathy to meet the criteria of plasma cell neoplasm.
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112. Which of the following patient factors is associated with a poorer prognosis for adults
diagnosed with acute myelogenous leukemia? A. Age of <55 years B. WBC count of >100,000 cells/mL C. History of myelodysplastic syndrome D. Positive results for Philadelphia chromosome |
Correct answer is C. RATIONALE: There several negative prognostic factors for patients with acute myelogenous leukemia (AML): older age, certain cytogenetic abnormalities, and the presence of antecedent hematological disorders. Myelodysplastic syndrome has been shown to be associated with a poorer outcome. The Philadelphia chromosome is more commonly present in patients with chronic myelogenous leukemia (CML) and acute lymphocytic leukemia (ALL), and it is not considered a prognostic factor for AML.
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114. A 42-year-old man presents with a 5-cm, raised, erythematous skin nodule overlying the
deltoid muscle. The lesion is slightly painful at times. Biopsy reveals marginal zone lymphoma. The patient's 5-year relative survival rate is approximately: A. 20%. B. 45%. C. 70%. D. 95%. |
Correct answer is D. RATIONALE: This represents a low-grade lymphoma of the skin and is in the favorable prognostic index (PI) group IA. The 5-year relative survival is 94% regardless of the therapy chosen. Reference: Smith, et al. Journal of Clinical Oncology. 2005;23:3390-3395.
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125. Which of the following genetic abnormalities is most commonly associated with chronic myelogenous leukemia?
A. t(8;14) B. t(9;22) C. t(11;22) D. Trisomy 8 |
Correct answer is B. RATIONALE: More than 90% of patients with chronic myelogenous leukemia (CML) have the Philadelphia chromosome with t(9;22).
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131. A 70-year-old woman has a stage IAE conjunctival, marginal zone, B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma. Which of the following radiation therapy approaches is most appropriate for this patient?
A. Local fractionated radiation therapy with a final dose of 55 Gy B. Local fractionated radiation therapy with a final dose of 30 Gy C. Bilateral orbital fractionated radiation therapy to 30 Gy D. Craniospinal irradiation to 23.4 Gy, followed by a boost dose to 45 Gy |
Correct answer is B. RATIONALE: Moderate doses of radiation therapy alone can provide excellent local control and cause specific survival outcomes (>90% at 10 years) in early-stage MALT lymphoma. It is not necessary to treat large fields or to use high doses. The role of chemotherapy vs. radiation therapy is controversial.
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136. What is the approximate annual risk that a patient who received radiation therapy for Hodgkin's lymphoma will have a second solid malignancy with non-breast histology after a latency period of 15 years?
A. 12% B. 05% C. 01% D. 00.01% |
Correct answer is C. RATIONALE: In general, the risk of a non-breast histology, second solid malignancy after radiation therapy for Hodgkin's lymphoma is roughly 0.9% per year after a latency period.
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141. Which of the following statements about solitary plasmacytoma is most appropriate?
A. A radiation dose of ≤30 Gy provides excellent local control. B. Adding chemotherapy after radiation therapy has not been shown to improve survival. C. The majority of patients will progress to multiple myeloma within 3 years after initial presentation. D. Patients with solitary plasmacytoma of the bone are at low risk for the development of multiple myeloma. |
Correct answer is B. RATIONALE: Chemotherapy has failed to show an improved outcome for patients with solitary plasma cell malignancy. Usually radiation doses in the range of 40 to 50 Gy are necessary to achieve high local control for solitary plasmacytomas. The majority of patients with solitary plasmacytoma will progress to multiple myeloma after >5 years, based on most reports. Patients with solitary bone plasmacytoma have a much higher chance of developing multiple myeloma compared to patients with extramedullary solitary plasmacytomas.
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164. A 32-year-old man with clinical stage IA nodular sclerosis Hodgkin's lymphoma of the right axilla receives 4 cycles of chemotherapy and experiences a complete response.
What would be the most appropriate dose of adjuvant radiation therapy? A. 40 Gy B. 30.6 Gy C. 18 Gy D. No radiation therapy is required. |
Correct answer is B. RATIONALE: The most appropriate dose of radiation therapy is 30.6 Gy for a patient who has early-stage nodular sclerosis Hodgkin’s lymphoma with no adverse risk factors and has had a complete response to multiagent chemotherapy.
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167. A 52-year-old patient with a 3-cm, stage IA large cell lymphoma in the left neck has a complete response to 3 cycles of CHOP chemotherapy based on PET/CT scans. Which of the following involved fields would be most appropriate to treat with radiation therapy?
A. Bilateral neck only B. Bilateral neck and left supraclavicular region C. Left neck, left supraclavicular region, and upper mediastinum D. Left neck and left supraclavicular region only |
Correct answer is D. RATIONALE: The left neck and left supraclavicular regions are
considered the appropriate involved-field region for the radiation therapy portal. Reference: Yahalom and Mauch. Annals of Oncology. 2002. |
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197. A 72-year-old man presents with a 6-cm painful mass in the right inguinal region. Biopsy and staging reveal grade 1 follicular lymphoma, stage 1A. What is the most appropriate treatment for this patient?
A. Radiation therapy alone B. Radiation therapy, followed by CHOP chemotherapy C. CHOP chemotherapy, followed by involved-field radiation therapy D. Observation |
Correct answer is A. RATIONALE: The patient will have an excellent response to radiation therapy alone and may experience durable local control. He has a high risk of failure outside of the radiation therapy (RT) port, but there is no survival benefit to the addition of systemic therapy either as an adjuvant to RT or before RT.
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222. Extramedullary plasmacytomas most commonly occur in which of the following
locations? A. Lower extremity B. Paraspinal musculature C. Head and neck D. Rectum |
Correct answer is C. RATIONALE: Approximately 80% of extramedullary plasmacytomas occur in the upper aero-digestive tract.
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246. For Hodgkin's or non-Hodgkin's lymphoma, complete response unconfirmed (CRu) is best defined as tumor shrinkage of:
A. ≤1.0 cm when the initial mass was 1.1 to 1.5 cm with negative functional imaging. B. ≤1.5 cm when the initial mass was >1.5 cm with negative functional imaging. C. >75% when the initial mass was >1.5 cm with negative functional imaging. D. <50% with failure to convert on functional imaging. |
Correct answer is C. RATIONALE: Options A and B define a complete response (CR), and option D defines no response (NR). Option C is the definition of a CRu.
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260. Which of the following diseases does NOT belong to the family of plasma cell
neoplasms? A. Plasma cell leukemia B. Plasma cell granuloma C. Monoclonal gammopathy of unknown significance D. Extraskeletal plasmacytoma |
Correct answer is B. RATIONALE: Knowledge of disease entities belonging to malignant plasma cell neoplasms is important when making decisions regarding their management.
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266. According to the EORTC, which of the following patient characteristics is a favorable risk factor for Hodgkin's lymphoma?
A. Age of >40 years B. ESR of >50 mm/hr C. ESR of >30 mm/hr with B symptoms D. Four or more sites of disease |
Correct answer is A. RATIONALE: An age of >50 years is an unfavorable risk factor for
Hodgkin’s lymphoma, according to the prognostic groups as defined by the European Organization for Research and Treatment of Cancer (EORTC). |
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268. Lymphocyte-predominant Hodgkin's disease consistently expresses high levels of what B-cell marker antigen?
A. CD4 B. CD15 C. CD20 D. CD30 |
Correct answer is C. RATIONALE: Lymphocyte-predominant Hodgkin’s disease, unlike the other 4 histological subtypes of Hodgkin's disease (nodular sclerosis, mixed-cellularity, lymphocyte-depleted, and lymphocyte-rich), which are CD15+ and CD30+, consistently expresses CD20.
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291. What is the approximate risk that acute lymphoblastic leukemia will spread to the CNS in adults who do not receive CNS-directed therapy?
A. 05% B. 10% C. 20% D. 35% |
Correct answer is D. RATIONALE: It is important for radiation oncologists to understand the risk of CNS spread for patients with acute lymphoblastic leukemia and the need for CNS directed therapy. Incidence of CNS spread can exceed 35% in adult patients who did not receive CNS prophylaxis. Reference: DeVita.
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293. In preparation for a bone marrow transplant, total body irradiation is delivered at a low dose rate to:
A. take advantage of cell cycle redistribution effects in any tumor cells that may be harbored among the bone marrow cells. B. provide time during the course of irradiation for reoxygenation of hypoxic bone marrow stem cells to occur. C. reduce the likelihood of the patient experiencing undesirable late complications (eg, lung fibrosis). D. differentially spare the platelet precursors, while maximizing killing of lymphoid precursors. |
Correct answer is C. RATIONALE: Although the bone marrow may not be spared by the use of low-dose-rate total body irradiation (due to the absence of sublethal damage recovery), the patient's other normal tissues would be spared, and accordingly, a lower frequency of early and late radiation effects would be expected.
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320. Which of the following is the most appropriate staging workup for a plasma cell
neoplasm? A. CT of the chest/abdomen/pelvis, bone marrow aspirate and biopsy, skeletal survey B. CT of the chest/abdomen/pelvis, serum and urine protein electrophoresis, bone marrow aspirate and biopsy C. Bone marrow aspirate and biopsy, skeletal survey, serum and urine protein electrophoresis D. Serum and urine protein electrophoresis, PET scan, 24-hour urine protein, bone marrow aspirate and biopsy |
Correct answer is C. RATIONALE: It is important for radiation oncologists to be familiar with workup for plasma cell neoplasms to be able to recognize the difference between solitary plasmacytoma and multiple myeloma, since they are treated with a different regimen. Bone marrow aspirate and biopsy, skeletal survey, serum and urine protein electrophoresis are the three major tests for workup.
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357. Which of the following genetic changes is the primary cause of chronic myelogenous leukemia (CML)?
A. Gene amplification B. Retroviral insertion C. Deletion of the CML gene D. Chromosomal translocation |
Correct answer is D. RATIONALE: Over 90% of chronic myelogenous leukemia (CML) cases result from a translocation between chromosomes 9 and 22 in which the bcr gene is placed adjacent to the abl gene, resulting in an aberrantly expressed gene product.
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23. Which of the following treatments should be used as first-line therapy for gastric MALT lymphoma to achieve complete tumor remission in the majority of patients?
A. Focal radiation field therapy after initial biopsy B. Combined chemotherapy and radiation therapy C. Antibiotic therapy for Helicobacter pylori D. Surgical resection combined with chemotherapy |
Correct answer is C. RATIONALE: Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is associated with Helicobacter pylori. More than two thirds of patients with this disease respond to antibiotic therapy, which is considered to be first-line therapy.
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32. Which of the following Ann Arbor stages would be most appropriate for a 15-year-old boy who has Hodgkin lymphoma with clinical and radiographic evidence of left neck and left supraclavicular fossa lymphadenopathy, generalized pruritus, and a 7-lb weight loss over the past 6 months?
A. Stage IA B. Stage IB C. Stage IIA D. Stage IIB |
Correct answer is A. RATIONALE: The neck and supraclavicular fossa constitute one region for lymphoma staging; therefore, this patient would have stage I disease. B symptoms include the following: 1) Loss of >10% weight loss over 6 months, 2) fever, 3) night sweats. Pruritus is not considered a B symptom.
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37. Which of the following imaging studies is most useful in the local evaluation of solitary plasmacytoma of the bone?
A. MRI B. CT scan C. Bone scan D. PET scan |
Correct answer is A. RATIONALE: It is important to evaluate the extent of the lesion appropriately. MRI provides the most complete anatomic information.
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42. What is the most common subtype of classical Hodgkin lymphoma?
A. Large B-cell B. Mixed cellularity C. Nodular sclerosing D. Lymphocyte depleted |
Correct answer is C. RATIONALE: Nodular-sclerosing Hodgkin lymphoma is the most common subtype of classic Hodgkin lymphoma, accounting for more than two thirds of all cases. Mixed-cellularity Hodgkin lymphoma is the next most common subtype at 30%, followed by lymphocyte-rich and lymphocyte-depleted Hodgkin lymphoma.
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54. What percent of children with acute lymphoblastic leukemia have CNS involvement at diagnosis?
A. 01% to 2% B. 03% to 5% C. 07% to 10% D. 12% to 15% |
Correct answer: ABCD. RATIONALE: CNS leukemia is present at diagnosis in 3% to 5% of children with acute lymphoblastic leukemia (ALL). REFERENCE: Pediatric Radiation Oncology. 3rd edition. Lippincott, Williams & Wilkins.
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60. Which of the following chromosomal translocations is most commonly associated with chronic myelogenous leukemia (CML)?
A. t(8;21) B. t(9;22) C. t(12;15) D. t(15;17) |
Correct answer is B. RATIONALE: It is important to recognize the proper diagnosis of chronic myelogenous leukemia (CML). The relationship of CML to chromosomal translocation t(9;22) is well documented.
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68. Which of the following characteristics is associated with the majority of patients who have follicular lymphoma?
A. It predominantly affects young adults. B. The Bcl-2 gene rearrangement is typically present. C. Bone marrow involvement is uncommon. D. Without therapy, the median survival of patients is less than 5 years. |
Correct answer is B. RATIONALE: The majority of patients with follicular lymphoma present with widespread disease and bone marrow involvement. The disease most commonly affects elderly patients. Due to its very indolent nature, even with observation, the median survival of these patients exceeds 5 years. The t(14;18) and Bcl-2 gene rearrangement is present in the majority of patients with follicular lymphoma.
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72. Which of the following sets of unfavorable prognostic criteria is used by the EORTC for patients with early-stage Hodgkin lymphoma?
A. "B" symptoms, age, pathology, extranodal sites, and number of involved sites B. "B" symptoms, age, erythrocyte sedimentation rate (ESR), mediastinal bulk, and number of involved sites C. "B" symptoms, pathology, ESR, mediastinal bulk, and number of lymph node sites D. Gender, ESR, mediastinal bulk, number of sites, and extranodal sites |
Correct answer is B. RATIONALE: The EORTC used the following criteria for assigning patients with early-stage Hodgkin lymphoma to the favorable vs. unfavorable prognostic group: "B" symptoms, age, erythrocyte sedimentation rate (ESR), mediastinal bulk, and the number of nodal sites.
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80. A patient with Hodgkin lymphoma has a 12-cm anterior mediastinal mass with bilateral involvement of the hilar lymph nodes and invasion of the anterior chest wall detected on CT scan. No disease is found below the diaphragm, and the patient has no "B" symptoms. Which of the following stages is associated with this patient's disease?
A. IAEX B. IIAEX C. IIIAEX D. IVAEX |
Correct answer is B. RATIONALE: Involvement of two lymph node regions (both hilum) on the same side of the diaphragm with localized contiguous involvement of a single extranodal site (chest wall), with >10-cm mass, and absence of "B" symptoms constitute stage IIAEX disease.
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90. What is the probability that solitary plasmacytoma of the bone will progress to multiple myeloma within 10 years?
A. 10% to 20% B. 30% to 40% C. 60% to 70% D. 80% to 90% |
Correct answer is C. RATIONALE: It is important to know this fact for counseling patients. The majority of patients will progress to multiple myeloma, and surveillance/follow-up is important after primary therapy.
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99. Which of the following chromosomal translocations is most closely associated with Burkitt's lymphoma?
A. t(8;14) B. t(11;14) C. t(11;18) D. t(14;18) |
Correct answer is A. RATIONALE: The (8;14) chromosomal translocation is most closely associated with Burkitt's lymphoma. The rest of the translocations are for mantle cell lymphoma (11;14), marginal cell lymphoma (11;18), and follicular cell (14;18) lymphoma.
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106. Extramedullary plasmacytoma is most commonly located in the:
A. lower extremities. B. head and neck. C. lungs. D. spine. |
Correct answer is B. RATIONALE: It is important to know where extramedullary plasmacytoma is located in making a differential diagnosis. Extramedullary plasmacytoma may involve the nasal cavity, sinuses, nasopharynx, tonsils, and larynx.
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186. Which of the following forms of leukemia is most appropriately treated with imatinib (STI571)?
A. Acute lymphocytic B. Acute myelogenous C. Chronic lymphocytic D. Chronic myelogenous |
Correct answer is D. RATIONALE: Imatinib is a tyrosine kinase inhibitor that is indicated for GI stromal tumors (GIST) and chronic myelogenous leukemia (CML). REFERENCE: FDA package insert.
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191. Which of the following types of leukemia has the highest incidence?
A. Acute myelogenous B. Acute lymphocytic C. Chronic myelogenous D. Chronic lymphocytic |
Correct answer is D. RATIONALE: It's important to know which type of leukemia presents most frequently. Chronic lymphocytic leukemia (CLL) is most common.
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205. Which of the following environmental exposures is a risk factor for the development of leukemia?
A. Chlorine B. Benzene C. Bromine D. Radon |
Correct answer is B. RATIONALE: It is important to be aware of risk factors for screening/counseling family members.
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219. Which of the following radiation doses is most appropriate for treatment of a solitary plasmacytoma involving the femur?
A. 25 Gy B. 36 Gy C. 45 Gy D. 60 Gy |
Correct answer is C. RATIONALE: It is important to know that the radiation dose for solitary plasmacytoma of the femur is higher than that for myeloma. The content of this item is somewhat controversial, since some may chose to use 36 Gy for treatment based on a more recent analysis. However, the weight of the evidence supports the dose chosen (i.e., >40 Gy).
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241. Which of the following factors is associated with the international prognostic score (IPS) for Hodgkin lymphoma?
A. Extranodal site B. Performance status C. Erythrocyte sedimentation rate D. Serum albumin level |
Correct answer is D. RATIONALE: A serum albumin level of <4 g/dL is the only factor belonging to the international prognostic score for Hodgkin lymphoma. REFERENCE: HasenClever, et al. New England Journal of Medicine (NEJM). 1998;1506-14.
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251. Which of the following types of non-Hodgkin lymphoma is most aggressive?
A. Mycosis fungoides B. Mantle cell C. Extranodal marginal zone B-cell D. Grades I and II follicular |
Correct answer is B. RATIONALE: Mantle cell lymphoma is mostly diagnosed as stage IV disease and is known to have a moderately aggressive course with median survival around 3 years. Follicular, extranodal marginal zone, and mycosis fungoides all have an indolent disease course. REFERENCE: DeVita.
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260. Which of the following histologies is most commonly associated with primary CNS lymphoma?
A. Mantle cell B. Large B-cell C. Anaplastic D. Follicular |
Correct answer is B. RATIONALE: Large B-cell lymphoma is the most common histology for CNS lymphoma. REFERENCE: DeVita VT, Hellman S, Rosenberg SA. Cancer: Principles & Practice of Oncology. 6th edition. Lippincott, Philadelphia; 2001;2300.
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280. Which of the following types of biopsy is most commonly used to diagnose Hodgkin lymphoma?
A. Excisional B. Incisional C. Fine-needle aspirate D. Random |
Correct answer is A. RATIONALE: Excisional biopsy is the preferred method of biopsy since it maintains architecture and sufficient material for immunohistochemistry flow cytometry.
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291. A 32-year-old woman has clinical stage IIA Hodgkin lymphoma. Which of the following doses of radiation therapy would be most appropriate if the patient achieves a complete response after 6 cycles of ABVD chemotherapy?
A. 44 Gy B. 36 Gy C. 30.6 Gy D. 20 Gy |
Correct answer is C. RATIONALE: National Comprehensive Cancer Network guidelines specify a radiation dose of 30 Gy for treatment of non-bulky clinical stage IIA Hodgkin lymphoma.
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300. Which of the following pathological features is characteristic of nodular lymphocyte-predominant Hodgkin lymphoma?
A. CD15−, CD30+, CD20+ B. CD15+, CD20+, CD22+ C. CD15+, CD30+, CD20− D. CD20+, CD15−, CD30− |
Correct answer is D. RATIONALE: Nodular lymphocyte-predominant Hodgkin lymphoma has distinct pathological features characterized by the presence of CD20+, CD15-, and CD30- cells. These features are different from classic Hodgkin lymphoma, which does not express CD20.
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313. Which of the following treatments achieves the best disease control in patients with primary CNS lymphoma?
A. Corticosteroids B. Whole-brain radiation therapy C. Debulking of the tumor mass before administration of chemoradiation D. Postsurgical chemotherapy only |
Correct answer is B. RATIONALE: It is important to avoid use of corticosteroids prior to establishing a histological diagnosis since they can cause a change in tumor appearance. Surgical resection will not affect disease outcome because of its multifocal nature. For the same reason, whole-brain irradiation is warranted for achieving disease control. Compared to all the modalities, radiation therapy is associated with the worse neurotoxicity, particularly in elderly patients.
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320. Which of the following factors has been found to affect the outcome of salvage therapy in patients with relapsed Hodgkin lymphoma?
A. Performance status B. Extranodal site of relapse C. Lactate dehydrogenase (LDH) levels D. Erythrocyte sedimentation rate (ESR) |
Correct answer is A. RATIONALE: The following factors are found to affect the outcome of patients with relapsed disease: duration of remission after initial therapy for <1 year, presence or absence of "B" symptoms, Karnofsky performance status <90, age >40 years.
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343. Which of the following outcomes was demonstrated in the ECOG E1482 (Horning) trial, which randomized involved-field radiation therapy (IFRT) versus observation after 8 cycles of CHOP in patients with high- and intermediate-risk stage I or stage II non-Hodgkin lymphoma?
A. Time to progression was the same in both study groups. B. Overall survival improved in patients who received IFRT after having a complete response to chemotherapy. C. Six-year disease-free survival and failure-free survival improved in patients who received IFRT after having a complete response to chemotherapy. D. Failure-free survival improved in patients who received IFRT after having a partial response to chemotherapy. |
Correct answer is C. RATIONALE: Patients with a complete response had improved 6-year disease-free survival (DFS), failure-free survival (FFS), and time to progression in the IFRT arm over the observation arm, but there was no difference in overall survival (OS). Patients achieving a complete response (CR) after 8 cycles of CHOP were treated to 30 Gy of IFRT, while patients with a partial response received 40 Gy of IFRT. Conversion to CR did not significantly influence clinical outcome of patients with initial PR from chemotherapy. REFERENCE: Horning, et al. Journal of Clinical Oncology (JCO). 2004;22(15).
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358. Rituximab binds to which of the following CD receptors?
A. CD20 B. CD15 C. CD8 D. CD4 |
Correct answer is A. RATIONALE: Rituximab is a chimeric monoclonal antibody that binds to the CD20 receptor expressed on B-cells to induce apoptosis. REFERENCE: FDA package insert.
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